Pulmonary Echography and BNP Value Pre- and Post- Elective Cesarean Section in Spinal Anesthesia
- Conditions
- Pregnancy Related
- Interventions
- Diagnostic Test: B-Type natriuretic peptide (BNP) serum valuesDevice: Pulmonary echographyOther: urine collection
- Registration Number
- NCT03851679
- Lead Sponsor
- University of Udine
- Brief Summary
Pregnancy is characterized by many biohumoral changes: circulation, respiratory mechanics, oncotic pressure, vascular permeability and many other systems are affected.
Vascular permeability is controlled by endothelial glycocalyx. Several factors such as sepsis, ischemia / reperfusion, inflammatory mediators, trauma, surgery including the Cesarean Section and fluid overload can increase vascular permeability due to a glycocalyx damage.
During Cesarean Section under subarachnoid anesthesia, hypotension may occur. It is a common side effect caused by reduced preload due to aortocaval compression by the uterus. Furthermore, subarachnoid anesthesia causes block of the sympathetic preganglionic fibers which is associated with vasodilation. These changes often require the use of vasopressors and fluids.
A fluid overload associated with the physiological and pathological factors discussed earlier might cause an increased risk of pulmonary edema and acute respiratory failure (IRA) in women undergoing cesarean section under arachnoid anesthesia.
IRA occurs in less than 0.2% of total pregnancies but it is one of the most common cause of admission to intensive care unit in pregnant women.
Among the causes that can lead to IRA in the last trimester of pregnancy we find pneumopathies such as asthma, pulmonary embolism due to amniotic fluid and pulmonary edema related to severe preeclampsia.
Diagnosis of pulmonary edema can be clinical or sub-clinical through laboratory tests such as BNP (b-type natriuretic peptide). It might also be necessary to execute instrumental examinations such as chest radiography (contraindicated in pregnancy) or trans-thoracic ultrasound.
Hypothesis: correlation between subarachnoid anesthesia, fluidic therapy and BNP values and ultrasound pattern
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 80
woman submit elective Cesarean Section:
- age > 18 years
- American Society of Anesthesiologists (ASA) physical status classification system > 2
- > 37 gestational age
- arterial pressure >/ = 140/90 mmHg and proteinuria < 300 mmHg during anesthesia pre-examination
- no known cardiovascular/respiratory disease
- pre-partum pulmonary echography
- age < 18 years
- pulmonary echographic windows not satisfying
- blood loss during Cesarean Section more than 1000 mL and/or necessity to administer colloid
- postpartum hemorrhage within the first 24 hours following childbirth
- pre-eclamptic sign/symptoms within the first 5 days following childbirth
- twin pregnancy
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description pregnancy woman urine collection woman who are submitted to elective Cesarean Section in spinal anesthesia pregnancy woman B-Type natriuretic peptide (BNP) serum values woman who are submitted to elective Cesarean Section in spinal anesthesia pregnancy woman Pulmonary echography woman who are submitted to elective Cesarean Section in spinal anesthesia
- Primary Outcome Measures
Name Time Method Ultrasound pulmonary variations pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery The main goal of our study is to evaluate, preoperatively, the incidence of ultrasound pulmonary variations in pregnant women attending elective Cesarean Section
- Secondary Outcome Measures
Name Time Method subclinical pulmonary echography variation pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery Evaluating the incidence of subclinical variations in ecographic lung characteristics at 6 and 24 hours after Cesarean Section
B-type natriuretic peptide serum value variation B-type natriuretic peptide serum level is sampled 30 minutes before Cesarean Section, 6 and 24 hours after surgery 30 minutes before Cesarean Section, 6 and 24 hours after surgery Finding if there is any correlation between preoperative b-type natriuretic peptide and ecographic lung characteristics in pregnants, before and 24 hours after Cesarean Section
fluid administration and pulmonary echography variation pulmonary echography is made 30 minutes before Cesarean Section, 6 and 24 hours after surgery Finding if there is any correlation between intraoperative fluids administered and ecographic lung characteristics